Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | LA011223 | LA |
NPI | 1023176989 |
---|---|
Provider Name | Richard John Campeau JR. |
First Address | New Orleans, LA 70115-4947 |
Second Address | New Orleans, LA 70115-4947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0115832 | (05) | LA |
01168432 | LA CAID (01) | LA |
B60467 | (02) |